HomeMy WebLinkAbout1419 Deciaratio~ of Domicile and Citisenship >
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State ot F~orida that I am filing this day in accordante and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes. '
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I was forme~ly a legal resident of ___A~~OkQ~$. _ Marvl an~ _ i
(City) (State) ~
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and 1 ~esided at _p.0~_ BQ?~_ 51 _ . Howeve~ 1 have changed my domiG~e
(Street and Number) j
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22nd '
to and am and have been a bona fide resident of the State of Florida since _ day of
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T_ MatCh 19_ 66and I reside at Rt 2~x 3400 Lakewood park ;
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of propery or business, or relinquishment of emptoyme~t
at former domicile, removal of family to new domicile, purchase of home, eic.)
Eatab2ishing residence ~
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AN~ REC R ~~~K i
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT ~
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PIERCE, SAINT LI~C~E: ~OUNTY, FLORIDA, permanently. ;
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~ ' : ; ; : ~ = ~ (Name) E
~ " ~u e Russell C pton ~
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~ Sworn to and subscribed before me this 23rd day of ~rch ~ 19 6b
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~ ROGER POITRAS
~ CIRCUIT COURT ~ Notary Public
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ey D.C. My Commission expires
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(To be ~x~cuted in dupliute and originsl filed with Clerlc G?cuif Court, and duplicat~ with Tax Ass~ssor.)
~ sooK 141 2l6 ~
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